Approximal Lesion-Infiltration Supplementary to F-Varnish In HCR-Population – 3YR-Results

Objectives: A protocol utilizing resin-infiltration shows clinical promise, supporting a less invasive approach to care: minimizing potential harms, preserving tooth structure and favorably husbanding healthcare resources. Combining multiple F-varnish applications with a proactive clinical approach utilizing split-mouth RCT study design with randomized control and resin-infiltration pairs, the efficacy of resin infiltration for stabilizing non-cavitated caries lesions is compared to the historically reactive and, often surgical, standard of care (SOC). Study aim: Evaluate approximal lesion infiltration's comparative efficacy when supplementary to the conventional SOC (watch-and-wait, pre-operative) management of High Caries Risk (HCR) patients.
Methods: 42 consented HCR-subjects (6.9+3.0 DMFT) were enrolled for management of two interproximal lesions. All patients received professional HCR-regimen: oral hygiene instructions, diet-counseling, dental prophylaxis, F-dentifrice and repeated F-varnish applications. Two affected E2/D1-surfaces were randomly treated by resin-infiltration (I - ICON, DMG) or mock-infiltration (C - control). Individually-standardized digital radiographs provided visual determination of lesion-size distribution at baseline and at recalls. Data were analyzed by logistic regression and McNemar test.
Results: 26 pairs (61.9%) presented for 3-YR recall evaluations. Visual radiographic assessment showed lesion-progression in both groups. 13 lesion pairs were stable. Categorical depth assessment (single radiographs) resulted in 7 discordant lesion pairs (4C and 3I lesions) and 1 concordant pair (1C, 1I lesion). Chronologic image sets were compared to YR3 and analyzed for changes in lesion-area and density over time. Pairwise assessment showed 7 additional lesions (6C, 1I) slowly progressing within category. The prevented fraction was 57.7% for C-lesions, and 80.8% for I-lesions.
Conclusions: After 3 years, comparative radiograph assessment revealed a 2.2 times larger prevented fraction after infiltration treatment. This data confirmed effective lesion inhibition after infiltration therapy. Long-term follow-up may further strengthen the evidence for efficacy of resin infiltration combined with SOC HCR-regimen including F-varnish.